Superbugs at the Gate

By SAM URETSKY

The Jan. 13, 2017, issue of Morbidity and Mortality Weekly Report (MMWR) had a report headed “Notes from the Field: Pan-Resistant New Delhi Metallo-Beta-Lactamase-Producing Klebsiella pneumoniae — Washoe County, Nevada, 2016.”

Scientific American’s headline made the point a lot more vividly : “Woman Killed by a Superbug Resistant to Every Available Antibiotic – The “nightmare bacteria” could fend off 26 different drugs.”

Most resistant bacteria are still sensitive to one or two antibiotics, but only one or two. A typical example is gonorrhea, which has become increasingly resistant to antibiotics. In the 1940s, when penicillin was first being used to treat human disease, 96 to 99 percent of cases of gonorrhea could be cured with what would not be one-quarter of a normal dose of penicillin G. For those cases that weren’t cured by the first dose, a second dose always worked. Now, the Centers for Disease Control and Prevention (CDC) has written tactfully, “Gonorrhea has progressively developed resistance to the antibiotic drugs prescribed to treat it. Following the spread of gonococcal fluoroquinolone resistance, the cephalosporin antibiotics have been the foundation of recommended treatment for gonorrhea. The emergence of cephalosporin-resistant gonorrhea would significantly complicate the ability of providers to treat gonorrhea successfully, since we have few antibiotic options left that are simple, well-studied, well-tolerated and highly effective.”

Whoever wrote that must have transferred from the diplomatic corps because elsewhere on its web site the CDC lists development of new treatments for gonorrhea as urgent. The World Health Organization is more reserved, listing the need for new treatment as second tier, “high.” One of the other bacteria also considered high priority is Helicobacter pylori, the bug that causes gastric ulcers. The WHO list has a number of common infections that are becoming increasingly difficult to treat. Once the resistant infections were “nosocomial,” hospital-acquired infections that had developed resistance because of the large amounts of antibiotics used in hospitals. Now resistant bacteria can be found almost anywhere. The CDC estimates that in the US 23,000 people die every year as a result of resistant bacteria

The major pharmaceutical companies haven’t kept up with the need for new antibiotics simply because antibiotics aren’t very profitable. Develop a new antibiotic, a physician orders it, and the patient takes it – for 10 days. Find a drug for high blood pressure and you’ve got a steady customer for years. Pharmaceutical companies have a responsibility to perform research in areas of need, but these studies really are costly, which is why the government sponsors preliminary scientific research – except that biomedical research is taking a big hit in President Trump’s proposed budget. That’s the cut of $5.8 billion he wants to cut from the National Institutes of Health budget, about 20%.

Fortunately this is one case where President Trump has the answer. The universities and laboratories will simply reduce their overhead costs.When a hospital or university receives a federal research grant, about 30% is for “overhead”, maintenance of the lab, repairs of equipment, cleaning the floors and replacing HEPA filters. President Tump’s plan is to fire all the janitors and have the PhDs and others with a D after their names, mop the floor and take out the garbage. Problem solved.

Last year the National Academy of Medicine issued a report “ The Neglected Dimension of Global Security: A Framework to Counter Infectious Disease Crises.” They report: “We have in the last few decades seen several large-scale outbreaks of infectious diseases, not only old foes—such as cholera and yellow fever — but new threats such as Ebola, SARS, hantavirus, HIV, and novel strains of influenza.

A range of factors, including increasing population, economic globalization, environmental degradation, and ever-increasing human interaction across the globe, are changing the dynamics of infectious diseases. As a consequence, we should anticipate a growing frequency of infectious disease threats to global security. We have not done nearly enough to prevent or prepare for such potential pandemics. While there are certainly gaps in our scientific defenses, the bigger problem is that leaders at all levels have not been giving these threats anything close to the priority they demand.”

We should be readying ourselves for the next pandemic, wherever it’s coming from. Instead, our leader is in full retreat, taking health care coverage away from millions and taking billions away from research. Maybe we can do better next time.

Sam Uretsky is a writer and pharmacist living in New York. Email sdu01@outlook.com.

From The Progressive Populist, May 15, 2017

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